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This article deals with the relation between the birth of criminology in late 19th century Romania and modernization. Scientific modernization also manifested itself through the adoption of laws, theories and methods from Western Europe that inspired various criminological discourses. However, this modernization was incomplete and stereotypes such as the gentleness of the Romanians had pervaded some of the criminological studies. Most Romanian authors interpreted crime as a socially determined phenomenon, rejecting the biological theories of crime. Towards the end of the 19th century, more and more authors tried to apply western criminological theories to phenomena and criminal cases from the Romanian society. [ABSTRACT FROM AUTHOR]

This study deals with a neglected topic-homicide rates in Old Kingdom Romania at the end of the 19th Century and the first years of the 20th Century. Starting from demographic and medical statistics that included information about the causes of death, we shall reveal what was a probable evolution of homicide rates both at a national level and for some of the most important cities as well. The data will be compared with that from other European countries/regions. Furthermore, homicides will also be examined in relation with other causes of death affecting the Romanian society. [ABSTRACT FROM AUTHOR]

Aliovalent substitutions in Ca3Co4O9 often result in complex effects on the electrical properties and the solubility, and impact of the substituting cation also depends largely on the preparation and processing method. It is also well-known that the monoclinic symmetry of this material's composite crystal structure allows for a significant hole transfer from the rock salt-type Ca2CoO3 buffer layers to the hexagonal CoO2 ones, increasing the concentration of holes and breaking the electron–hole symmetry from the latter layers. This work explored the relevant effects of relatively low La-for-Ca substitutions, for samples prepared and processed through a conventional ceramic route, chosen for its simplicity. The obtained results show that the actual substitution level does not exceed 0.03 (x < 0.03) in Ca3−xLaxCo4O9 samples with x = 0.01, 0.03, 0.05 and 0.07 and that further introduction of lanthanum results in simultaneous Ca3Co4O9 phase decomposition and secondary Ca3Co2O6 and (La,Ca)CoO3 phase formation. The microstructural effects promoted by this phase evolution have a moderate influence on the electronic transport. The electrical measurements and determined average oxidation state of cobalt at room temperature suggest that the present La substitutions might only have a minor effect on the concentration of charge carriers and/or their mobility. The electrical resistivity values of the Ca3−xLaxCo4O9 samples with x = 0.01, 0.03 and 0.05 were found to be ~1.3 times (or 24%) lower (considering mean values) than those measured for the pristine Ca3Co4O9 samples, while the changes in Seebeck coefficient values were only moderate. The highest power factor value calculated for Ca2.99La0.01Co4O9 (~0.28 mW/K2m at 800 °C) is among the best found in the literature for similar materials. The obtained results suggest that low rare-earth substitutions in the rock salt-type layers can be a promising pathway in designing and improving these p-type thermoelectric oxides, provided by the strong interplay between the mobility of charge carriers and their concentration, capable of breaking the electron–hole symmetry from the conductive layers. [ABSTRACT FROM AUTHOR]

This work further explores the possibilities for designing the high-temperature electrical performance of the thermoelectric Ca3Co4O9 phase, by a composite approach involving separate metallic iron and nickel particles additions, and by employing two different sintering schemes, capable to promote the controlled interactions between the components, encouraged by our recent promising results obtained for similar cobalt additions. Iron and nickel were chosen because of their similarities with cobalt. The maximum power factor value of around 200 μWm−1K−2 at 925 K was achieved for the composite with the nominal nickel content of 3% vol., processed via the two-step sintering cycle, which provides the highest densification from this work. The effectiveness of the proposed approach was shown to be strongly dependent on the processing conditions and added amounts of metallic particles. Although the conventional one-step approach results in Fe- and Ni-containing composites with the major content of the thermoelectric Ca3Co4O9 phase, their electrical performance was found to be significantly lower than for the Co-containing analogue, due to the presence of less-conducting phases and excessive porosity. In contrast, the relatively high performance of the composite with a nominal nickel content of 3% vol. processed via a two-step approach is related to the specific microstructural features from this sample, including minimal porosity and the presence of the Ca2Co2O5 phase, which partially compensate the complete decomposition of the Ca3Co4O9 matrix. The obtained results demonstrate different pathways to tailor the phase composition of Ca3Co4O9-based materials, with a corresponding impact on the thermoelectric performance, and highlight the necessity of more controllable approaches for the phase composition tuning, including lower amounts and different morphologies of the dispersed metallic phases. [ABSTRACT FROM AUTHOR]

Massive gastrointestinal bleeding is rarely caused by infectious etiologies especially with esophageal localization. Even if Cytomegalovirus Infection (CMV) is not often encountered in the clinical practice, it has to be taken into account when the cause of GI hemorrhage is not obvious. We report a case of a 53 years old, male patient, with diabetes who is admitted in the hospital for cellulitis of the left calf and who developed massive hematemesis with no obvious source at the upper GI endoscopy. The patient was treated conservatory with PPI and transfusions of blood but he repeated the hemorrhage after 5 days with severe hypotension and a drop of hemoglobin to 6g/dl.The second endoscopy revealed massive clots in the esophagus with erythema and deep ulcers underneath while the stomach and duodenum were normal. Multiple biopsies were taken from esophageal ulcers and normal mucosa. We suspected viral esophagitis with CMV and we started treatment with Valganciclovir for 21 days with favorable clinical course. The infection was then confirmed by the pathology department and the immunohistochemical studies. The control endoscopy after one month showed healed esophageal ulcers with minimal residual lesions. [ABSTRACT FROM AUTHOR]

The diagnosis and treatment of benign biliary strictures (BBS) are often challenging. In the past, surgery was the treatment of choice in the majority of cases. Nowadays the endoscopic treatment of BBS is preferred over surgery because it is less invasive, repeatable and associated with lower morbidity rates. The endoscopic retrograde cholangiopancreatography (ERCP) can make the diagnosis of the stricture, and provide its dilation and stent placement. Temporary insertion of multiple side-by-side large-bore plastic stent is the standard of care in endoscopic therapy. The use of uncovered self-expanding metal stents is under investigation. Most commonly BBS occur in the evolution of chronic pancreatitis, and after liver transplant or cholecystectomy. The efficacy of endoscopic therapies is different and depends on the cause of BBS. Though it has limitations, endoscopic therapy has a favourable safety profile and remains a first-line management option in benign biliary strictures. Endoscopic therapy may be considered a bridge to surgery in some cases of chronic pancreatitis or in nonanastomotic strictures after liver transplant. [ABSTRACT FROM AUTHOR]

Massive gastrointestinal bleeding is rarely caused by infectious etiologies especially with esophageal localization. Even if Cytomegalovirus Infection (CMV) is not often encountered in the clinical practice, it has to be taken into account when the cause of GI hemorrhage is not obvious. We report a case of a 53 years old, male patient, with diabetes who is admitted in the hospital for cellulitis of the left calf and who developed massive hematemesis with no obvious source at the upper GI endoscopy. The patient was treated conservatory with PPI and transfusions of blood but he repeated the hemorrhage after 5 days with severe hypotension and a drop of hemoglobin to 6g/dl.The second endoscopy revealed massive clots in the esophagus with erythema and deep ulcers underneath while the stomach and duodenum were normal. Multiple biopsies were taken from esophageal ulcers and normal mucosa. We suspected viral esophagitis with CMV and we started treatment with Valganciclovir for 21 days with favorable clinical course. The infection was then confi rmed by the pathology department and the immunohistochemical studies. The control endoscopy after one month showed healed esophageal ulcers with minimal residual lesions. [ABSTRACT FROM AUTHOR]

Liver dysfunction is not an uncommon association with malignancy. However, obstructive jaundice as the first clinical presentation of metastatic carcinoma of the prostate is rare with only a few such cases reported in the literature. The aetiology of obstructive jaundice in these cases can be due to direct invasion of the tumour or external compression of the biliary tree or, rarely, related to a paraneoplastic phenomenon. Here, we report a case of obstructive jaundice being the presenting symptom of metastatic carcinoma of the prostate secondary to lymph node obstruction and review the literature. [ABSTRACT FROM AUTHOR]

The diagnosis and treatment of benign biliary strictures (BBS) are often challenging. In the past, surgery was the treatment of choice in the majority of cases. Nowadays the endoscopic treatment of BBS is preferred over surgery because it is less invasive, repeatable and associated with lower morbidity rates. The endoscopic retrograde cholangiopancreatography (ERCP) can make the diagnosis of the stricture, and provide its dilation and stent placement. Temporary insertion of multiple side-by-side large-bore plastic stent is the standard of care in endoscopic therapy. The use of uncovered self-expanding metal stents is under investigation. Most commonly BBS occur in the evolution of chronic pancreatitis, and after liver transplant or cholecystectomy. The efficacy of endoscopic therapies is different and depends on the cause of BBS. Though it has limitations, endoscopic therapy has a favourable safety profile and remains a first-line management option in benign biliary strictures. Endoscopic therapy may be considered a bridge to surgery in some cases of chronic pancreatitis or in nonanastomotic strictures after liver transplant. [ABSTRACT FROM AUTHOR]

Introduction. The management of biliary tract infections involves systemic antibiotherapy and a biliary drainage procedure. Current guidelines provide recommendations for empirical antimicrobial therapy in cholangitis but development of multi-drug resistant organisms can make many of these antibiotics ineffective. This study aimed to analyze the microbiology of bile and the susceptibility profiles of organisms identified in patients with extrahepatic cholestatis, with or without a previously placed biliary stent. Materials and methods. We conducted a prospective study including 136 patients with biliary obstruction who were endoscopically drained between June 2014 and March 2015 in Emergency Hospital “Floreasca”, Bucharest. One hundred and four of these patients had no biliary stent in situ (group 1). Thirty-two procedures were performed in patients with at least one biliary stent in place (group 2). Microbiological examination of bile aspirates was performed and antibiotic susceptibilities were determined for the isolated bacteria. Results. One hundred eighteen of 136 analyzed cultures were positive (81% in group 1 vs. 100% in group 2; p<0.05). In both groups, the most frequent pathogens were Escherichia coli, Klebsiella spp. and Proteus spp. The most effective antimicrobial agents against Gram-negative bacteria in group 1 and group 2 were imipenem, cefoperazone/sulbactam and piperacillin/tazobactam. Susceptibilities to ceftazidime, cefotaxime, cefepime and fluoroquinolones were significantly lower in group 2. Conclusion. This survey shows that Gram-negative bacteria are the predominant bile pathogens found in patients with cholestatis. Cefoperazone/sulbactam, piperacillin/tazobactam or imipenem can be recommended in biliary infections. Cephalosporins and fluroquinolones should not be used as empirical therapy if a biliary stent is in place. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 28-year-old female who developed gastric fistulas following laparoscopic sleeve gastrectomy, successfully managed using Padlock Clips. Topics discussed include the clinical challenges of post-sleeve gastrectomy complications, the effectiveness of Padlock Clips in fistula closure, and the role of conservative treatment in facilitating recovery without surgical intervention.

Introduction. Inflammatory bowel diseases and intestinal tuberculosis (TB) have similar clinical and endoscopic appearance, one of the main differences between those two entities being the presence of caseation necrosis as seen by the histopathological examination, which is specifically for TB. Case presentation. 35-year-old woman presented to our hospital for significant weight loss and mild anemia. Endoscopy and colonoscopy were both performed. Colonoscopy revealed multiple ulcers and important edema affecting the transverse colon, which made the colonoscope advancement impossible. Biopsies were taken from the affected segment and further investigations were made in order to exclude any enteral infections. We suspected Chron's disease so screening tests for detecting TB, HIV infections and viral chronic hepatitis were also performed in order to initiate biological treatment. Tests results came negative for any systemic or enteral infections, but QuantiFERON TB Gold test was inconclusive. As the chest-X ray revealed no lesions and the biopsy revealed chronic granulomatous colitis without caseation necrosis we decided to repeat the test, which came back negative. We started anti-TNF alpha therapy with infliximab and further evolution of the disease was favorable. Two months after the treatment initiation the patient presented to the emergency room with fever, abdominal pain and ascites fluid. CT scan was performed and multiple abscesses were also identified. The patient underwent surgery with right ileo-colectomy and ileostomy. Fragments were recovered and sent for histopathological examination. This time huge granulomas with caseation necrosis were identified, suggesting intestinal TB. Discussions. Intestinal TB represents 12% of the extra-pulmonary TB cases and the prevalence around the world is about 1-3%. From those cases, TB most frequently affects the ileo-cecum site, due to several factors such as physiological stasis, narrow lumen, the low activity of the digestion and the high prevalence of lymphoid tissue. On the other hand, isolated TB of the colon is rarely seen and represents almost 11% of all intestinal TB cases. Conclusions. Romania represents an endemic country for TB so detailed differential diagnosis should be made, especially with inflammatory bowel disease, as their treatment, more specifically biological therapy could lead to important complications, such as abscesses as it was our patient's case. Unfortunately, in this situation if it wasn't for the biological therapy that led to the aggravation of the TB, the disease would be treated as an inflammatory bowel disease and the diagnosis would be delayed even more. [ABSTRACT FROM AUTHOR]

Introduction: Acute hypoxemic respiratory failure may have different causes. Case presentation: We present the case of a 42-year-old woman, with history of recent thyroidectomy and a late history of sleeve gastrectomy, who presented for acute dyspnoea. The chest X-ray revealed hydropneumothorax, and, therefore, an intercostals chest tube drainage was inserted. The evolution was unfavourable, with further respiratory status deterioration. A computed tomography of the thorax and abdomen was performed, that revealed a dilated thoracic oesophagus and stenosis of the esophagogastric junction, with lack of substance in the oesophageal wall and extravasation of oesophageal content in the posterior mediastinum, due to an oesophageal pleural fi stula. An oesophageal stent was inserted under endoscopic guidance and the patient underwent minim-invasive surgical interventions for evacuation of the mediastinal and pleural collections, with a favourable evolution. Conclusions: Acute respiratory failure can be the face of multiple conditions, some of these can be life threatening and in need for rapid detection and treatment. [ABSTRACT FROM AUTHOR]

Objectives: Over the past two decades has been a dramatic worldwide increase in both incidence and severity of Clostridium Difficile infection (CDI). Several studies showed worse clinical outcomes in Inflammatory Bowel Disease (IBD) patients with CDI, including longer hospital stay, higher colectomy and mortality rates than in those without CDI. The aim of our study was to evaluate the prevalence of Clostridium difficile infection in IBD patients and to evaluate the particularities of diagnosis and treatment. Methodology: We performed a retrospective study that included 15 patients from a group of 220 IBD patients admitted in the Gastroenterology Department of the Clinical Emergency Hospital Bucharest between 2013- 2016 having also Clostridium Difficile infection. Results: The patients mean age was 44.1 years. The prevalence of CDI in patients with inflammatory bowel disease was 6.81%. Patients with ulcerative colitis were more susceptible to CDI (86.6%), than those with Crohn's disease (13.3%). We studied also the response to treatment. Metronidazole alone was effective in 33.3% of cases. Vancomycin combined with Metronidazole was effective in 60% of cases. Refractory CDI unresponsive to 48 hours of conventional therapy appeared in 6.6% of cases. The eradication was achieved only with Tigecycline and fecal microbiota transplant. Imunosupressive therapy was continued in all cases, concomitant with Metronidazole/Vancomicin. Conclusions: Patients with ulcerative colitis are at higher risk for CDI and have a poor prognosis than those with Crohn's disease. Average age of CDI in IBD patients significantly is lower than in general population. In IBD patients, presenting with diarrhea or a change in bowel habits, practitioners need to test for C. difficile and differentiate CDI symptoms from a disease flare. Special care to rule out C. difficile should be pursued prior to escalating or starting new immunosuppressive agents. Fecal microbiota transplant, probiotics, and newer antibiotics are good alternatives for refractory disease. [ABSTRACT FROM AUTHOR]

The pancreatic cancer has the worst prognosis among gastrointestinal cancers, with a mortality rate close to incidence. The analysis on the globe carried out by GLOBOCAN in 2012 places the pancreatic cancer on the 13th place in terms of incidence and on the 8th place in terms of mortality of all cancers and in relation with digestive cancers it occupies the 6th place for both epidemiological indices. The high mortality is justified by the paucity of symptoms, since it becomes clinically manifest upon the onset of secondary determinations and the lack of response to treatment. 80-85% of the patients come in the stage of non-resecability. The lack of sensitive tumoral markers specific to the early diagnosis of the pancreatic cancer has a major contribution to the poor prognosis. The goal of this article is to present all the discoveries that have been made so far in the field of biomarkers involved in the pancreatic cancer, namely CEA carcinoembryonic antigen, CA19-9 antigen and microRNA. [ABSTRACT FROM AUTHOR]

Crohn's disease and intestinal tuberculosis (TB) share many clinical, radiological and endoscopic features. A definitive diagnosis in these cases is extremely important, to avoid the toxicity of unnecessary antituberculous therapy in patients with Crohn's disease and potentially fatal immunosuppressive treatment in patients with intestinal TB. A 42-year-old male presented with weight loss, recurrent fever, diarrhea, right iliac fossa pain, night sweats for several months. Abdominal ultrasonography with ileo-cecal wall thickening and retroperitoneal adenopathies and colonoscopy evaluation were thought to be consistent with Crohn's disease. However, the diagnosis was disseminated tuberculosis with lung and colon involvement based on the diffuse, bilateral small nodules seen on Chest X-ray and tuberculoid granulomas revealed on the colon biopsies. [ABSTRACT FROM AUTHOR]

Introduction. Distinguishing Crohn's disease (CD) and intestinal tubeculosis (ITB) may represent a remarkable clinical dilemma in Romania, an endemic country for tuberculosis which has experienced at the same time a significant increase in the incidence of inflammatory bowel disease. Case presentation. A 22 years-old female presented in our unit for abdominal pain, diarrhea (3-4 stools/day) and weight loss (7 kg.) since approximately 9 months ago. Previous investigations from another hospital included an abdominal ultrasound which revealed thickened enteral loops with intensified parietal Doppler signal suggestive of inflammation; fecal calprotectin was extremely elevated (>20.000 ug/mg). In our unit, we ordered stool tests that were negative for bacterial, viral or parasitic infections. Complete blood count, renal, liver and coagulations tests were within normal limits. We decided to perform colonoscopy; ileocecal valve stenosis was noted due to marked edematous mucosal changes, ulcerations and nodularity. Passage of the endoscope in the terminal ileum was not possible due to the ulcerohypertrophic lesions, but multiple biopsies were taken from the stenotic area. Even though Crohn's disease was highly suspected we decided to perform chest X-ray since intermittent cough and night chills were also noted during hospitalization. Radiographical findings consisted of numerous small nodular opacities up to 3-5mm diameter scattered throughout both lungs highly suggestive of miliary TB. Both sputum culture (intense BAAR reaction), CT scan and biopsies confirmed tuberculosis with extraintestinal manifestations. Our patient is currently under antimycobacterial treatment with favorable clinical outcome. A further follow-up to reassess the ileocecal valve stenosis is expected. Discussions. Intestinal tuberculosis and Crohn's disease have multiple overlapping features in terms of symptoms, radiologic, endoscopic and even histological findings. Misdiagnosis can be a crucial error, since immunosuppressive therapy for CD may favor the spread of tuberculosis and worsens prognosis. There are case reports in the literature with disseminated tuberculosis after anti-TNF therapy for suspected CD. Miliary tuberculosis with extraintestinal manifestations is not frequently encountered in immunocompetent patients. Nevertheless, initial results (including HIV testing and CT scan) did not identify any potential deficiency of the immune system in our patient. Conclusions. Judicious clinical examination merged with radiological, endoscopic and histological findings is of utmost importance in proper distinction between intestinal tuberculosis and Crohn's disease, to a great degree in Romania which is still endemic for the former. [ABSTRACT FROM AUTHOR]

Background: Iron deficiency anemia is the most common cause of anemia worldwide. The differential diagnosis of this entity remains one of the most encountered problems: from thalassemia, neoplasia, malabsorbtion syndrome to chronic kidney disease under hemodialysis. Case report: This case report describes clinical and paraclinical features of a 75-year-old patient with multiple comorbidities and iron deficiency anemia. We emphasize on the importance of endoscopic videocapsule examination for the accurate diagnosis of iron deficiency anemia when other methods fail (endoscopy and colonoscopy), thus revealing the source of bleeding in a small bowel benign polyp. Thus, tumors of the small intestine present as a unique challenging diagnosis. Conclusion: Endoscopic videocapsule, even if expensive, should remain an important tool in the diagnosis of iron deficiency anemia with normal upper GI endoscopy and colonoscopy. Small bowel tumors are seldom considered as a diagnostic hypothesis, but should not be overlooked, especially when alarm symptoms are present (weight loss, melena, hematochesia). [ABSTRACT FROM AUTHOR]

The pancreatic cancer has the worst prognosis among gastrointestinal cancers, with a mortality rate close to incidence. The analysis on the globe carried out by GLOBOCAN in 2012 places the pancreatic cancer on the 13th place in terms of incidence and on the 8th place in terms of mortality of all cancers and in relation with digestive cancers it occupies the 6th place for both epidemiological indices. The high mortality is justifi ed by the paucity of symptoms, since it becomes clinically manifest upon the onset of secondary determinations and the lack of response to treatment. 80-85% of the patients come in the stage of non-resecability. The lack of sensitive tumoral markers specifi c to the early diagnosis of the pancreatic cancer has a major contribution to the poor prognosis. The goal of this article is to present all the discoveries that have been made so far in the fi eld of biomarkers involved in the pancreatic cancer, namely CEA carcinoembryonic antigen, CA19-9 antigen and microRNA. [ABSTRACT FROM AUTHOR]

Crohn's disease and intestinal tuberculosis (TB) share many clinical, radiological and endoscopic features. A defi nitive diagnosis in these cases is extremely important, to avoid the toxicity of unnecessary antituberculous therapy in patients with Crohn's disease and potentially fatal immunosuppressive treatment in patients with intestinal TB. A 42-year-old male presented with weight loss, recurrent fever, diarrhea, right iliac fossa pain, night sweats for several months. Abdominal ultrasonography with ileo-cecal wall thickening and retroperitoneal adenopathies and colonoscopy evaluation were thought to be consistent with Crohn's disease. However, the diagnosis was disseminated tuberculosis with lung and colon involvement based on the diffuse, bilateral small nodules seen on Chest X-ray and tuberculoid granulomas revealed on the colon biopsies. [ABSTRACT FROM AUTHOR]

Objectives: Over the past two decades has been a dramatic worldwide increase in both incidence and severity of Clostridium Diffi cile infection (CDI). Several studies showed worse clinical outcomes in Inflammatory Bowel Disease (IBD) patients with CDI, including longer hospital stay, higher colectomy and mortality rates than in those without CDI. The aim of our study was to evaluate the prevalence of Clostridium diffi cile infection in IBD patients and to evaluate the particularities of diagnosis and treatment. Methodology: We performed a retrospective study that included 15 patients from a group of 220 IBD patients admitted in the Gastroenterology Department of the Clinical Emergency Hospital Bucharest between 2013- 2016 having also Clostridium Diffi cile infection. Results: The patients mean age was 44.1 years. The prevalence of CDI in patients with inflammatory bowel disease was 6.81%. Patients with ulcerative colitis were more susceptible to CDI (86.6%), than those with Crohn's disease (13.3%). We studied also the response to treatment. Metronidazole alone was effective in 33.3% of cases. Vancomycin combined with Metronidazole was effective in 60% of cases. Refractory CDI unresponsive to 48 hours of conventional therapy appeared in 6.6% of cases. The eradication was achieved only with Tigecycline and fecal microbiota transplant. Imunosupressive therapy was continued in all cases, concomitant with Metronidazole/Vancomicin. Conclusions: Patients with ulcerative colitis are at higher risk for CDI and have a poor prognosis than those with Crohn's disease. Average age of CDI in IBD patients signifi cantly is lower than in general population. In IBD patients, presenting with diarrhea or a change in bowel habits, practitioners need to test for C. diffi cile and differentiate CDI symptoms from a disease flare. Special care to rule out C. diffi cile should be pursued prior to escalating or starting new immunosuppressive agents. Fecal microbiota transplant, probiotics, and newer antibiotics are good alternatives for refractory disease. [ABSTRACT FROM AUTHOR]

Introduction. The colonic pathology associated with the administration of nonsteroidal anti-inflammatory drugs is vast and includes inflammation, ulcerations and sometimes strictures. It is important to identify the NSAIDs-induced alterations in the colon in order to differentiate them from other pathologies and to avoid treatment errors. The objective of this paper is to present a post-NSAIDs colopathy revealed by lower digestive bleeding - hematochezia. Material and methods. A 68 years old patient under treatment with NSAIDs is hospitalized for hematochezia. Laboratory tests, upper and lower digestive endoscopy are performed and multiple colonic ulcers are identified. Results. Following the investigations, the suspicion of post-NSAIDs colonic ulcers is raised and a differential diagnosis with inflammatory bowel disease is sought by taking multiple biopsies. The histopathological examination shows ischemic necrosis, with no pathognomonic elements linked to Crohn’s disease. Conclusions. The peculiarity of this case resides in the importance of identifying the NSAIDs-induced pathology and differentiating it from other pathologies to prevent treatment errors. Associating multiple ulcers in NSAIDs pathology is rare and often misdiagnosed as Crohn's disease. Keep in mind the importance of the histopathologic exam, which excluded the inflammatory bowel disease in a patient with inconclusive inflammatory biological evidence. [ABSTRACT FROM AUTHOR]

Pancreatic cancer is one of the most aggressive malignant neoplastic diseases. The incidence and mortality rates of this disease vary depending on geographical area, which might be explained by the different exposure to risk factors. To improve the prognosis of patients with pancreatic cancer, different approaches are needed for an earlier diagnosis. Identification of risk factors and implementation of screening strategies are essential for a better prognosis. Currently, the risk factors for pancreatic cancer fall into two broad categories, namely extrinsic and intrinsic factors. Extrinsic factors include alcohol consumption, smoking, a diet rich in saturated fats, and viral infections such as chronic infection with hepatitis B and C viruses. The pathophysiological mechanisms explaining how these hepatotropic viruses contribute to the development of pancreatic cancer are not fully elucidated. The common origin of hepatocytes and pancreatic cells in the multipotent endodermal cells, the common origin of the blood vessels and biliary ducts of the pancreas and the liver, or chronic inflammatory changes may be involved in this interaction. A careful monitoring of patients with viral liver infections may contribute to the early diagnosis of pancreatic cancer and improve the prognosis of these patients. [ABSTRACT FROM AUTHOR]

Background & Aims. A point mutation (gp130Y757F/ Y759F) was identified as being responsible for aberrant activation of gp130 in mice and associated with gastric adenocarcinoma induction. As a result, we investigated the possible role of key point mutations in Tyr from IL6ST exon 17 that encode for the catalytic domain of gp130, and of its respective activators (IL-6 family member cytokines) in human gastric cancer initiation and development. Method. DNA, protein and plasma from 51 patients with gastric adenocarcinoma have been used in exploring gp130 status. We used sequencing analysis of IL6ST exon 17 in order to identify possible mutations that would lead to constitutive active forms of the receptor. The levels of gp130 activators (IL-6, IL-11, LIF) were analyzed by ELISA in plasma and mucosa of patients with gastric adenocarcinoma. Results. Sequencing analysis did not identify mutations in gp130 key positions (Y759, Y767, Y814, Y905 and Y915). An increased IL-6 and IL-11 level in gastric mucosa was observed, correlated with staging, indicating these cytokines as gp130 activators in tumor epithelial cell. Those variations were consistent with increased IL-6 level in plasma. Furthermore, IL-6, but not IL-11 showed a significant correlation with patient's survival time, suggesting that tissue and plasma concentration of IL-6 might be a marker of tumor aggressiveness with prognostic value. Conclusions. According to our results, no mutations were detected in gp130 key positions in human gastric adenocarcinoma samples. However, gp130 activation may occur due to the increased level of IL-6 and IL-11 cytokines detected that can become valuable biomarkers. [ABSTRACT FROM AUTHOR]

The present study aims to assess the sleep characteristics and health-related quality of life (HRQOL) among patients with chronic liver diseases (CLDs), as well as the relationship between them. We conducted a prospective cross-sectional study, over a period of eight months, on patients with CLDs. Sleep was assessed by subjective tools (self-reported validated questionnaires), semi-objective methods (actigraphy), and HRQOL by using the 36-Item Short Form Survey (SF-36) and Chronic Liver Disease Questionnaire (CLDQ). The results indicated that 48.21% of patients with CLDs had a mean Pittsburgh Sleep Quality Index (PSQI) score higher than five, suggestive of poor sleep; 39.29% of patients had a mean Epworth Sleepiness Scale (ESS) score ≥11, indicative of daytime sleepiness. Actigraphy monitoring showed that patients with cirrhosis had significantly more delayed bedtime hours and get-up hours, more awakenings, and more reduced sleep efficacy when compared to pre-cirrhotics. The CLDQ and SF-36 questionnaire scores were significantly lower in cirrhotics compared to pre-cirrhotics within each domain. Moreover, we identified significant correlations between the variables from each questionnaire, referring to HRQOL and sleep parameters. In conclusion, sleep disturbances are commonly encountered among patients with CLDs and are associated with impaired HRQOL. This is the first study in Romania that assesses sleep by actigraphy in a cohort of patients with different stages of CLD. [ABSTRACT FROM AUTHOR]

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. They are potentially malignant, and have an unpredictable evolution. The origin of these tumors is in the interstitial cells of Cajal, which are cells that are interposed between the intramural neurons and the smooth muscle cells of the digestive tract. GISTs are characterized by mutations in the gene c-Kit, but also other mutations, such as those of the platelet-derived growth factor receptor alpha. The most common locations of these tumors are the stomach and small intestine, although they can occur at any level of the digestive tract and occasionally in the omentum, mesentery and peritoneum. Most cases of GISTs are sporadic, and about 5% of cases are part of family genetic syndromes. The correct diagnosis of GIST is determined by histopathological examination and immunohistochemistry. According to histopathology, there are three main types of GISTs: spindle cell type, epithelioid type and mixed type. The therapeutic management of GIST includes surgery, endoscopic treatment and chemotherapy. The prognosis of patients with GIST varies depending on a number of factors, such as risk category, GIST stage, treatment applied and recurrence after treatment. [ABSTRACT FROM AUTHOR]

Background: Pancreatic ductal adenocarcinoma (PDAC), the most prevalent neoplastic lethal pancreatic disease, has a poor prognosis and an increasing incidence. The insulin-like growth factor-1 receptor (IGF-1R) signaling pathway is considered to be a contributing factor to the progression, metastasis, and therapy resistance of PDAC. Currently available treatment options for PDAC are limited, but microRNAs (miRNAs) may represent a new therapeutic strategy for targeting genes involved in the IGF-1R signaling pathway. Method: We investigated the expression levels of 21 miRNAs involved in the IGF-1R signaling pathway in pancreatic tissue from 38 patients with PDAC and 11 controls (five patients with chronic pancreatitis and six patients with normal pancreatic tissue). Results: We found 19 differentially expressed miRNAs between the PDAC cases and the controls. In particular, miR-100-5p, miR-145-5p, miR-29c-3p, miR-9-5p, and miR-195-5p were exclusively downregulated in PDAC tissue but not in chronic pancreatitis or normal pancreatic tissues; both control types presented similar levels. We also identified miR-29a-3p, miR-29b-3p, and miR-7-5p as downregulated miRNAs in PDAC tissues as compared with normal tissues but not with pancreatitis tissues. Conclusions: We identified a panel of miRNAs that could represent putative therapeutic targets for the development of new miRNA-based therapies for PDAC. [ABSTRACT FROM AUTHOR]

In this work, brownmillerite-type calcium ferrite (Ca 2 Fe 2 O 5) ceramics were prepared by two distinct routes, namely by a proteic sol-gel synthesis using commercial flavorless gelatin, and by a solid-state reaction method using mollusk shells. XRD analyses revealed single phase brownmillerite-type calcium ferrites in both cases. SEM-EDS analysis of sintered Ca 2 Fe 2 O 5 ceramics revealed larger grain sizes for the samples prepared via the solid-state reaction. All samples possessed a p-type conduction mechanism, with the largest power factor of ~2 ​μW ​m-1 K−2 at 450 ​°C observed for the samples obtained via the solid state reaction. The charge transport mechanism was found to depend on the preparation route. The obtained results demonstrated that the proposed synthesis routes can be successfully employed for the preparation of single-phase brownmillerite-type materials. Microstructure and electrical properties of calcium ferrite obtained by two environmentally friendly synthesis methods. [Display omitted] • Calcium ferrite synthesized by a proteic sol-gel route. • Solid-state reaction route using mollusk shells, as a source of calcium carbonate. • Low-cost and environmentally friendly methods for synthesizing Ca2Fe2O5. • Structural, microstructural and electrical properties of calcium ferrite. [ABSTRACT FROM AUTHOR]

Introduction: Globally, cancer is the leading cause of mortality, with colorectal neoplasia ranking third in terms of incidence and mortality worldwide. Patients face disease- and treatment-specific impacts, which can significantly influence their quality of life (QoL). Aim: This study aimed to propose a protocol to measure in-hospital and long-term QoL in patients with complicated colorectal cancer (CRC). Material and Methods: multicenter prospective observational cohort study. Results: QoL is a multidimensional concept that includes criteria for physical, mental, emotional, and social functionality as perceived by the patient. Periodically evaluating QoL offers measurable and objective tools to intervene at the appropriate time to decrease the Years of Life Lost and Years Lived with Disabilities for CRC patients. However, a structured and functional system requires dedicated and common institutional effort. A pilot study using this protocol included 69 patients, 65.12+-10.92 years, M:F ratio = 56.5:43.5%. Surgical procedure was right hemicolectomy, left colectomy, transverse colectomy, sigmoidectomy, total colectomy, rectal resection, and colorectal resection with stoma (ileostomy or colostomy) in 21.7%, 11.6%, 2.9%, 11.6%, 1.4%, 23.2%, and 27.5% of the cases, respectively. The mean Global Health Status Score, Symptom Score, and Functional Score was 82.36+-18.60, 11.89+-10.27, and 86.27, 74.50-94.11, respectively. Conclusions: CRC diagnosis has major effects on patients physical and psychological status, and concentrated efforts should be made by the involved medical team and healthcare systems to improve QoL throughout the treatment pathway., (Celsius.)

Cholangiocarcinoma (CCA) is an adenocarcinoma originating from the epithelial cells of the bile ducts/hepatocytes or peribiliary glands. There are three types of cholangiocarcinoma: intrahepatic, perihilar and distal. CCA represents approximately 3% of the gastrointestinal malignancies. The incidence of CCA is higher in regions of the Eastern world compared to the Western countries. There are multiple risk factors associated with cholangiocarcinoma such as liver fluke, primary sclerosing cholangitis, chronic hepatitis B, liver cirrhosis and non-alcoholic fatty liver disease. Endoscopy plays an important role in the diagnosis and management of cholangiocarcinoma. The main endoscopic methods used for diagnosis, biliary drainage and delivering intrabiliary local therapies are endoscopic retrograde cholangiopancreatography and endoscopic ultrasound. The purpose of this review is to analyze the current data found in literature about cholangiocarcinoma, with a focus on the actual diagnostic tools and endoscopic management options.

MXenes, a family of two-dimensional (2D) transition metal carbides, have been discovered as exciting candidates for various energy storage and conversion applications, including green hydrogen production by water splitting. Today, these materials mostly remain interesting objects for in-depth fundamental studies and scientific curiosity due to issues related to their preparation and environmental stability, limiting potential industrial applications. This work proposes a simple and inexpensive concept of composite electrodes composed of molybdenum- and titanium-containing MAX phases and MXene as functional materials. The concept is based on the modification of the initial MAX phase by the addition of metallic Ni, tuning Al- and carbon content and synthesis conditions, followed by fluoride-free etching under alkaline conditions. The proposed methodology allows producing a composite electrode with a well-developed 3D porous MAX phase-based structure acting as a support for electrocatalytic species, including MXene, and possessing good mechanical integrity. Electrochemical tests have shown a high electrochemical activity of such electrodes towards the hydrogen evolution reaction (HER), combined with a relatively high areal capacitance (up to 10 F cm -2 )., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Monitoring disease activity in inflammatory bowel disease (IBD) is challenging since clinical manifestations do not represent reliable surrogates for an accurate reflection of the inflammatory burden. Endoscopic remission had been the most significant endpoint target in the last years; nevertheless, a remarkable proportion of patients continue to relapse despite a normal-appearing mucosa, highlighting that endoscopy may underestimate the true extent of the disease. A subtle hint of the importance that histology plays in the long-term course of the disease has been endorsed by the STRIDE-II consensus, which recommends considering histologic healing for ulcerative colitis (UC), even though it is not stated to be a compulsory formal target. It is a continuum-changing paradigm, and it is almost a certainty that in the near future, histologic healing may become the new formal target for ulcerative colitis. It must be emphasized that there is great heterogeneity in defining histological remission, and the main criteria or cut-off values for inflammatory markers are still in an ill-defined area. The complexity of some histologic scores is a source of confusion among clinicians and pathologists, leading to low adherence in clinical practice when it comes to a homogenous histopathological report. Therefore, a standardized and more practical approach is urgently needed.

Background and Aims: Real-world assessments of efficacy and safety of advanced therapies used for inflammatory bowel disease (IBD) patients are limited. We aimed to report safety, efficacy and treatment persistence of new molecules (infliximab, adalimumab, vedolizumab, tofacitinib, ustekinumab) in a retrospective multicentric national Romanian analysis., Methods: We conducted a nationwide, retrospective observational multicentric study. Data were collected retrospectively from electronic and paper files. Patients who started on one of the five investigated molecules during December 2019-December 2021 were included. The main outcome measures were clinical remission, endoscopic healing, persistence on treatment and safety data., Results: A total of 678 adult patients from 24 Romanian IBD centers with a diagnosis of ulcerative colitis or Crohn's disease were included. Participants had previously failure to one (268, 39.5%), two (108, 15%) or more treatment lines and only 38% (259) were biologic naïve. In the 24 months study period, most patients were started on vedolizumab (192, 28%), followed by adalimumab, infliximab, ustekinumab and tofacitinib. In biologic-naïve patients, most physicians (72%) preferred anti-TNF treatment as first line biologic (93 patients started on infliximab, 92 on adalimumab), followed by vedolizumab, ustekinumab and tofacitinib. During follow-up, 71% (470, p=0.05) of patients achieved clinical remission and 36% (134, p=0.03) achieved mucosal healing. The 6 months milestone for persistence was reached in 78% (530) of cases. Almost half of patients (47%, 316 patients) persisted on their current treatment for over 12 months. Overall, an adverse reaction was reported for 67 (10.4%) patients, with no lethal events., Conclusions: Population of biologic-experienced IBD patients in Romania is increasing and is becoming more difficult to achieve long-term disease control. Discontinuation rates for advanced therapies are high.

There are several overlapping clinical practice guidelines in acute pancreatitis (AP), however, none of them contains suggestions on patient discharge. The Hungarian Pancreatic Study Group (HPSG) has recently developed a laboratory data and symptom-based discharge protocol which needs to be validated. (1) A survey was conducted involving all members of the International Association of Pancreatology (IAP) to understand the characteristics of international discharge protocols. (2) We investigated the safety and effectiveness of the HPSG-discharge protocol. According to our international survey, 87.5% (49/56) of the centres had no discharge protocol. Patients discharged based on protocols have a significantly shorter median length of hospitalization (LOH) (7 (5;10) days vs. 8 (5;12) days) p < 0.001), and a lower rate of readmission due to recurrent AP episodes (p = 0.005). There was no difference in median discharge CRP level among the international cohorts (p = 0.586). HPSG-protocol resulted in the shortest LOH (6 (5;9) days) and highest median CRP (35.40 (13.78; 68.40) mg/l). Safety was confirmed by the low rate of readmittance (n = 35; 5%). Discharge protocol is necessary in AP. The discharge protocol used in this study is the first clinically proven protocol. Developing and testifying further protocols are needed to better standardize patients' care., (© 2023. The Author(s).)

Artificial intelligence (AI) is a term that covers a multitude of techniques that are used in a manner that tries to reproduce human intelligence. AI is helpful in various medical specialties that use imaging for diagnostic purposes, and gastroenterology is no exception. In this field, AI has several applications, such as detecting and classifying polyps, detecting the malignancy in polyps, diagnosing Helicobacter pylori infection, gastritis, inflammatory bowel disease, gastric cancer, esophageal neoplasia, and pancreatic and hepatic lesions. The aim of this mini-review is to analyze the currently available studies regarding AI in the field of gastroenterology and hepatology and to discuss its main applications as well as its main limitations.

Background and Objectives: Biologic therapy has fundamentally changed the opportunity of medical treatment to induce and maintain remission in inflammatory bowel disease (IBD). Nevertheless, the rate of surgery is still at a very high rate, profoundly affecting the quality of life. We aimed to analyze surgical cases at three major IBD units in order to identify the main risk factors and the impact of biologic therapy on pre- and postsurgical outcomes. Material and Methods: This was a multicenter retrospective cohort study that included 56 patients with IBD-related surgical interventions from 3 tertiary care hospitals in Bucharest, Romania. The study was conducted between January 2017 and June 2021. All data were retrospectively collected from the medical records of the patients and included the age at diagnosis, age at the time of surgery, IBD type and phenotype, biologic therapy before or/and after surgery, timing of biologic therapy initiation, extraintestinal manifestations, type of surgery (elective/emergency), early and long-term postoperative complications and a history of smoking. Results: A low rate of surgical interventions was noted in our cohort (10.3%), but half of these occurred in the first year after the IBD diagnosis. A total of 48% of the surgical interventions had been performed in an emergency setting, which seemed to be associated with a high rate of long-term postoperative complications. We found no statistically significant differences between IBD patients undergoing treatments with biologics before surgery and patients who did not receive biologics before the surgical intervention in terms of the IBD phenotype, type of surgery and postoperative complications. Conclusion: Our study showed that biologics initiated before the surgical intervention did not influence the postoperative complications. Moreover, we demonstrated that patients with Crohn's disease and no biologics were the most susceptible to having to undergo surgery. Conclusion: In conclusion, the management of patients with IBD requires a multidisciplinary approach that considers an unpredictable evolution.

The development and progression of colorectal cancer (CRC) have been associated with inflammation processes that involve the overactivation of the NF-κB signalling pathway. The characterization of the NF-κB expression profile in CRC is an important topic since the suppression of NF-κB represents a potential therapeutic approach. In this study, we assessed the expression levels of 84 NF-κB-related genes in paired tumoral (T) and peritumoral (PT) tissues from 18 CRC patients and 18 normal colonic mucosae, and the expression levels of three miRNAs targeting the most dysregulated genes revealed by the case-control analysis. Comparing the gene expression profile of T and controls, 60 genes were dysregulated. The comparison of T and PT revealed 17 dysregulated genes in the tumoral tissues, with IL1B, CXCL8, IL1A, and CSF2 being the most upregulated. Notably, through a bioinformatics analysis, the differential gene expression of 11 out of the 17 genes was validated on a larger cohort of 308 CRC patients compared with 41 controls. Moreover, a decrease in the levels of RELA, NOD1, CASP8, BCL2L1, ELK1, and IKBKB was identified in poorly differentiated tumours compared to moderately differentiated tumours. The analysis of the three miRNAs targeting IL1B, CXCL8, IL1A, and CSF2 showed that miR-182-5p was upregulated in T compared with PT, whereas miR-10b-5p was downregulated in T compared with PT and control tissues. Our results may contribute to the design of new experimental therapeutic strategies based on endogenous molecules, such as miRNAs, to target the genetic key players of the NF- κB pathway., (© 2022 The Authors. Journal of Cellular and Molecular Medicine published by Foundation for Cellular and Molecular Medicine and John Wiley & Sons Ltd.)

In this research, as an alternative to chemical and physical methods, environmentally and cost-effective antimicrobial zinc oxide nanoparticles (ZnO NP) were produced by the green synthesis method. The current study focuses on the production of ZnO NP starting from adequate precursor and Zingiber officinale aqueous root extracts (ginger). The produced ZnO NP was loaded into electrospun nanofibers at different concentrations for various tissue engineering applications such as wound dressings. The produced ZnO NPs and ZnO NP-loaded nanofibers were examined by Scanning Electron Microscopy (SEM) for morphological assessments and Fourier-transform infrared spectrum (FT-IR) for chemical assessments. The disc diffusion method was used to test the antimicrobial activity of ZnO NP and ZnO NP-loaded nanofibers against three representatives strains, Escherichia coli (Gram-negative bacteria), Staphylococcus aureus (Gram-positive bacteria), and Candida albicans (fungi) microorganisms. The strength and stretching of the produced fibers were assessed using tensile tests. Since water absorption and weight loss behaviors are very important in tissue engineering applications, swelling and degradation analyses were applied to the produced nanofibers. Finally, the MTT test was applied to analyze biocompatibility. According to the findings, ZnO NP-loaded nanofibers were successfully synthesized using a green precipitation approach and can be employed in tissue engineering applications such as wound dressing., Competing Interests: The authors declare that they have no financial interest in this paper.

Background: Cholangiocarcinoma is the most common malignancy of the bile ducts causing intrahepatic, hilar, or distal bile duct obstruction. Most jaundiced patients are diagnosed with unresectable tumors in need for palliative bile duct drainage and chemotherapy. Endobiliary radiofrequency ablation (RFA) is an adjuvant technique that may be applied prior to biliary stenting. The aim of our study was to assess the efficacy of endobiliary RFA prior to stent insertion in patients with unresectable distal cholangiocarcinomas., Methods: Twenty-five patients (eight treated with RFA and stenting and 17 treated with stenting alone) were included in a case-controlled study. We prospectively assessed the impact of RFA on the survival rate, the patient performance status, and the preservation of eligibility for chemotherapy based on the patient laboratory profile., Results: Patients treated with RFA prior to stenting proved to have a significantly longer survival interval (19 vs. 16 months, p = 0.04, 95% CI) and significantly better performance status. Moreover, the laboratory profiles of patients treated with RFA has been proven superior in terms of total bilirubin, liver enzymes, and kidney function, thus making patients likely eligible for palliative chemotherapy. Post-ERCP adverse events were scarce in both the study group and the control group., Conclusion: Given the isolated adverse events and the impact on the patient survival, performance, and laboratory profile, RFA can be considered safe and efficient in the management of patients with unresectable distal cholangiocarcinomas.

Introduction: Pancreatic malignancies represent highly fatal diseases with poor prognosis and constantly increasing incidence despite modern diagnostic and therapeutic options. Both endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are regarded as mainstays in pancreatic cancer management. The present study aims to evaluate whether accuracy EUS with fine-needle aspiration or biopsy (FNA or FNB) in pancreatic cancer diagnosis is influenced by prior biliary stenting or by technical or anatomical features (stent type, number of needle passes, common bile duct or Wirsung's diameter, topographical characteristics and diameter of the pancreatic tumor)., Materials and Methods: This retrospective study includes 243 patients with pancreatic cancer who underwent ERCP and EUS with fine-needle aspiration or biopsy (FNA or FNB)., Results and Discussion: Out of the total number of patients, 68 were stented prior to EUS. We found that the EUS-FNA diagnostic yield is not influenced either by the presence of biliary stent, nor by the type of stent (plastic or metallic). Moreover, the mean needle passes required were similar for both stented patients and not stented ones., Conclusions: Ultimately, given our results, we can state that EUS-FNA/FNB can be safely and accurately performed in the presence of biliary stents., (© 2022 Wiley Periodicals LLC.)

Background and Aim. Endoscopic therapy is the method of choice in the management of biliary strictures after orthotopic liver transplantation (OLT). Even though the mainstay approach for OLT stricture complications is represented by consecutive procedures of multiple plastic stents (MPS) insertion, a valuable alternative is the use of fully covered self-expandable metal stents (FCSEMS). The aim of the study was to compare MPS with FCSEMS used in the management of OLT biliary strictures, in terms of clinical outcomes and complications. Material and Methods. This is a retrospective, single-center study conducted between February 2014 and November 2019 in the Clinical Emergency Hospital of Bucharest, Romania. We enrolled all consecutive patients who developed biliary strictures after OLT and were treated by endoscopic retrograde cholangiopancreatography (ERCP) either with MPS or FCSEMS. Results. Thirty-six patients were included in the study, 27 patients had MPS and nine patients had FCSEMS. 106 ERCP procedures were performed and 159 stents were inserted. The mean number of ERCP procedures required per patient was significantly higher for MPS than for FCSEMS (3.34 ± 1.46 vs. 2.11 ± 0.33, p < 0.001). In the FCSEMS group only one patient had three procedures, due to stent migration. Difficult cannulation was encountered in 22 patients, 18 patients from MPS group and four patients from FCSEMS group. Dilation was performed in 20 (77%) MPS patients and in four FCSEMS patients (44%). Overall, we used 159 stents for stricture resolution, 149 plastic stents and 10 FCSEMS. Mean number of stents inserted was significantly lower in the FCSEMS group compared to MPS group (1.16 ± 0.40 vs. 5.73 ± 2.64, p < 0.001). Conclusions. Stricture resolution using FCSEMS is comparable to MPS and even has some advantages. In line with prior studies, FCSEMS are effective, with fewer complications and similar outcome compared to plastic stents. Other particular aspects should be further assessed, especially long-term follow up of FCSEMS and their cost efficiency.

Introduction and Aim: Sleep disorders are highly prevalent in patients with liver cirrhosis. The aim of this study was to investigate the prevalence of restless legs syndrome (RLS), as well as its risk factors and possible predictors, in a cohort of patients with liver cirrhosis., Material and Methods: We performed a cross-sectional prospective study over a period of 14 months and enrolled 69 patients with liver cirrhosis, after applying the inclusion and exclusion criteria. The cases of RLS were assessed according to the International Restless Legs Syndrome Study Group (IRLSSG) criteria and severity scale., Results: Out of the total number of patients, 55% fulfilled the criteria for RLS. Age, diabetes, severity of cirrhosis, serum creatinine, glomerular filtration rate (GFR), and mean hemoglobin were associated with the presence of RLS. Moreover, there was a significantly higher prevalence of RLS among patients with decompensated cirrhosis. From all the risk factors introduced into the multivariate analysis, only the GFR could predict the presence of RLS., Conclusions: This research shows that patients with liver cirrhosis have a high risk of RLS. Even though there are multiple risk factors associated with RLS, only the GFR could predict its occurrence in our cohort.

Introduction/Aim. The aim of this study was to assess the prevalence of cognitive impairments and their association with sleep patterns in a cohort of patients diagnosed with chronic liver disease (CLD). Material and methods. The present paper is a prospective cohort study, carried out over a period of 12 months, among patients with various stages of CLD. We evaluated the cognitive function through psychometric hepatic encephalopathy score (PHES), while sleep was assessed by actigraphy and two self-reported questionnaires: Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). Results. Seventy-four patients with CLD were considered eligible and were enrolled between December 2020−November 2021. The prevalence of minimal hepatic encephalopathy (MHE) in the entire cohort was 41.9%, and the diagnosis was considered for PHES scores ≤ −3. Patients with cirrhosis recorded significantly lower PHES scores compared to patients with other CLDs but without cirrhosis (−3.19 ± 3.89 vs. 0.19 ± 2.92, p < 0.05). Patients who exhibited MHE suffered from poor sleep, daytime somnolence, disturbed nighttime sleep, and low overall sleep efficacy. Patients diagnosed with MHE and undergoing treatment with lactulose and/or rifaximin for prevention of overt hepatic encephalopathy (HE) showed better results in terms of sleep parameters compared to patients diagnosed with MHE but without treatment. Conclusions. This research increases awareness regarding the connection between sleep features and MHE in patients with cirrhosis and other CLDs. A deeper insight into the subclinical stages of HE and associated sleep disturbances is warranted in future studies.